I have been suffering from what is termed 'deep' acne since I was 18 (I am now 35). This presents itself as long-lasting, very hard, large, deep-rooted red sores inflaming the skin around my nose and mouth, and is currently being kept not-quite under control by oxytetracycline. I do not want to spend the rest of my life on antibiotics, and anyway, they do not allow my skin to become clear for any length of time.

Can you suggest anything that would allow me to wean myself off the antibiotics and prevent further acne from disfiguring my face? I have also heard that diet does not contribute to this condition. Thanks very much for your help.

The Dermatologist Dr Mark Goodfield

As well as oxytetracycline, you should be prescribed a topical treatment (eg benzoyl peroxide - an antiseptic face cleanser that acts on bacteria and the grease gland directly), as a two-pronged approach is essential for effective results. Dietary changes are unlikely to make a significant impact, but for women, hormone treatment can be successful. A version of the pill is used: it blocks male hormones (the driving force in persistent acne), but it is a control rather than a cure and obviously isn't an option for you! Isotretinion is a vitamin A derivative drug (one trade name is Roaccutane) that works for both sexes.

and is prescribed by a dermatologist. It gives an 85 to 90 per cent chance of curing acne, although there are potential side effects - for example, it can harm unborn babies. A drug-free option is blue light, a version of UV light, or vitamin A cleansers/gels to help the lining of the skin.

· Dr Mark Goodfield is a consultant dermatologist and honorary secretary of the British Skin Foundation

The fellow sufferer Alison Bowser

I had terrible acne for 12 years, so I do appreciate your problem. Oxytetracycline was one of my first treatments, but as a 14-year-old I was rubbish at taking the tablets, and it didn't work. It must be taken an hour before food and on an empty stomach - are you doing this? Also, your doctor should have prescribed you some cream with the oral antibiotics. That said, I respect the fact that you don't want to be on antibiotics for ever. I felt the same and tried everything - cutting out chocolate, eating bananas, buying expensive soaps - but the thing that finally worked for me was Roaccutane. Get referred by your GP to a dermatologist who can talk you through all your options.

Bring along a photo of your acne at its worst (invariably your skin will clear up just as you're going to see an expert), so he or she can appreciate the seriousness of your problem. And don't give up - acne is treatable if you persevere.

·Alison Bowser is the chief executive of the Acne Support Group (0870 870 2263; stopspots.org

The holistic doctor Dr John Briffa

Acne that develops in adolescence is often related to high levels of hormones called androgens. Elevated androgen levels are a common underlying factor in persistent acne in women and can be investigated with blood tests. While antibiotics may help, they are also known to erode healthy bacteria in the gut and lead to the emergence of potentially harmful organisms, such as yeast. In natural medicine, yeast overgrowth is believed to increase levels of toxicity, and can be a potential underlying factor in acne. Also, the emergence of unhealthy organisms in the gut can lead to some 'leakiness' in the gut wall, which may exacerbate skin conditions by allowing partially digested food and other potential toxins into the system. The management of these issues can be complex and needs to be individualised. I recommend advice from a naturopath (08707 456984; naturopathy.org.uk

· Dr John Briffa is a holistic doctor specialising in nutritional medicine drbriffa.com